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ETPL POLICY AND PROCEDURES ATTACHMENT 3 ETPL LOCAL BOARD DELEGATION AND CANCELATION FORM .... ........... ........................—........................... A Local Workforce Development Board (Local Board) may delegate or cancel responsibility of the California (CA) and local Eligible Training Provider List (ETPL) to an appointed Local Board by completing this form, This form must be completed at the time of a change (delegation or cancelation), and annually in July to ensure the State ETPL Coordinator is able to coordinate with the appropriate Local Board. I 1 Please sign (physical or electronic) and submit the completed form to the Employment Development Department via email to WSBETPL@edd.ca.gov. Select either the Delegation or Cancelation box: ❑ DELEGATION -Delegating Local Board is assigning responsibility for the CA and local ETPL to the Appointed Local Board, and the Appointed Local Board agrees to coordinate the CA and local ETPL on behalf of the Delegating Local Board. Signatures are required of the Delegating and Appointed Local Board's Executive Director. ❑CANCELATION-Delegating Local Board is revoking responsibility for the CA and local ETPL i to the Appointed Local Board. The Delegating Local Board will resume responsibility for the CA and local ETPL unless a new Local Board is assigned this responsibility. Signatures are required of the Delegating and Appointed Local Board's Executive Director. ------------- --- ------ ------- - Delegating Local Board: Delegating Local Board Executive Director Name: Signature: Date: Appointed Local Board: .................. Appointed Local Board Executive Director Name: Signature: Date: ------------- WSD21-03 Page I of 1